Dr Brown's views will be supported by many who read this paper which
might have been less contentious in some of its statements if an
anaesthetist had been amongst the authors. If groups are going to make
comments about the use (or lack of use) of a particular technique then
they should include a relevant expert among them to provide the necessary
input. Having relieved myself of that whinge, I think that there are other
issues which need further comment.
The name of the area (general ward or high dependency area) in which
patients are managed after major surgery (with or without an epidural)
matters naught: what matters is the quality/quantity of medical and
nursing care available. However, the staff involved must also have
expertise and experience in the supervision of patients receiving epidural
analgesia if it is to be used safely and effectively. In many hospitals
that level of care can only be guaranteed in the defined high dependency
unit, although if the level of care available in a general ward is not
appropriate to epidural supervision I am not sure I would want major
surgery there anyway, no matter what type of analgesia was used!
As to the debate about the influence of epidural analgesia on
surgical outcome, Dr Brown refers correctly to two important studies, but
ignores the many questions which surround these papers and the subject as
a whole. Space precludes full consideration of these questions here, but
one key point is that no one has ever disputed that the quality of pain
relief is vastly superior. In a perfect world that should be evidence
enough, but the other questions do need to be addressd[1]. I believe that
properly conducted and managed (easy to state, harder to achieve) epidural
analgesia can provide marked benefits: we simply have not proved it yet in
the wider setting.
1. Wildsmith JAW. No sceptic me, but the long day’s task is not yet
done: The 2002 Gaston Labat Lecture. Regional Anesthesia & Pain
Management 2002; 27: 503-8.
Competing interests:
I have acted as a consultant to, and received research funding from, AstraZeneca
Rapid Response:
Re: use of epidurals for colorectal surgery
Dr Brown's views will be supported by many who read this paper which
might have been less contentious in some of its statements if an
anaesthetist had been amongst the authors. If groups are going to make
comments about the use (or lack of use) of a particular technique then
they should include a relevant expert among them to provide the necessary
input. Having relieved myself of that whinge, I think that there are other
issues which need further comment.
The name of the area (general ward or high dependency area) in which
patients are managed after major surgery (with or without an epidural)
matters naught: what matters is the quality/quantity of medical and
nursing care available. However, the staff involved must also have
expertise and experience in the supervision of patients receiving epidural
analgesia if it is to be used safely and effectively. In many hospitals
that level of care can only be guaranteed in the defined high dependency
unit, although if the level of care available in a general ward is not
appropriate to epidural supervision I am not sure I would want major
surgery there anyway, no matter what type of analgesia was used!
As to the debate about the influence of epidural analgesia on
surgical outcome, Dr Brown refers correctly to two important studies, but
ignores the many questions which surround these papers and the subject as
a whole. Space precludes full consideration of these questions here, but
one key point is that no one has ever disputed that the quality of pain
relief is vastly superior. In a perfect world that should be evidence
enough, but the other questions do need to be addressd[1]. I believe that
properly conducted and managed (easy to state, harder to achieve) epidural
analgesia can provide marked benefits: we simply have not proved it yet in
the wider setting.
1. Wildsmith JAW. No sceptic me, but the long day’s task is not yet
done: The 2002 Gaston Labat Lecture. Regional Anesthesia & Pain
Management 2002; 27: 503-8.
Competing interests:
I have acted as a consultant to, and received research funding from, AstraZeneca
Competing interests: No competing interests